Tracheostomy device

ABSTRACT

A tracheostomy device has a short tube terminating adjacent the internal end of an opening into the trachea. A flange secures the external end of the tube and a retainer secures the internal end of the tube against the surface of the trachea. The device also includes a seal, which engages the surface of the trachea above the opening, and a suction passage extending externally by which secretions can be removed.

BACKGROUND OF THE INVENTION

This invention relates to tracheostomy devices of the kind including atubular member adapted to provide a gas passage into the trachea throughan opening in neck tissues and an external retainer for retaining thetubular member with the external surface of the neck adjacent theopening.

FIELD OF INVENTION

A tracheostomy is used to enable direct access for breathing gases intothe trachea through a surgically-made opening in the throat. The airwayinto the trachea is usually maintained with a tracheostomy tube. Thetracheostomy tube has a patient end angled so that its axis is directedgenerally caudally along the trachea. The tube is bent along its lengthso that the machine end emerges through the tracheostomy and isterminated by a coupling and a flange to which a strap is secured. Thestrap extends about the neck of the patient and is used to hold the tubein position. Tracheostomy tubes often have an inflatable cuff close tothe patient end, which seals with the inside of the trachea, so as toconfine gas flow to the bore of the tube. Tracheostomy tubes may havefenestrations above the cuff to allow some air flow to the larynx andthereby enable the patient to speak.

Tracheostomy tubes have been used satisfactorily for many years.However, they do suffer from a number of disadvantages. First, duringuse, secretions build up on the inside of the tube, which provide a sitefor the accumulation of bacteria. Release of these secretions into therespiratory passages is thought to be associated with a high prevalenceof pneumonia infection in ventilated patients. For this reason,tracheostomy tubes must be carefully cleaned regularly. Alternatively,the tube may have a liner or inner cannula that is periodically removedand disposed of. These inner cannula have their own problems, such as inreducing the bore through the tracheostomy tube. The maintenancenecessary for tracheostomy tubes is an additional burden on hospitalstaff and requires the establishment of procedures to ensure that themaintenance is carried out correctly and routinely. Another problem withtracheostomy tubes is that they need to be secured to the neck by meansof a strap or the like. This makes the tubes more conspicuous, which isa particular problem to patients where the tube needs to be in place forprolonged periods. A further problem arises with cuffed tubes in thatsecretions produced in the upper part of the trachea, above the cuff onthe tube, tend to collect on the inflated cuff, between the outside ofthe tube and the trachea. Although some of these secretions can beremoved by suctioning, it is difficult to remove all secretions from theconfined space between the tube and trachea.

It is an object of the present invention to provide an alternativetracheostomy device.

SUMMARY OF INVENTION

According to one aspect of the present invention there is provided atracheostomy device of the above-specified kind, characterised in thatthe patient end of the tubular member terminates adjacent the internalend of the opening, and that the device includes an internal retainerfor retaining the tubular member with the internal surface of thetrachea adjacent the opening.

The device preferably includes a seal for substantially sealing thetrachea above the opening into the trachea. The seal may have a fluidpassage, such as a suction passage, opening at one end above the sealand extending out of the trachea via the opening. The seal preferablyincludes a deformable annular ring arranged to engage the surface of thetrachea. The annular ring may be inflatable or it may include aresilient foam. The seal may include a web extending across the ring.The external retainer is preferably a flange and the internal retainermay be a displaceable member, such as a hinged tab and the tab may beconnected with a cord by which the tab can be displace.

According to a second aspect of the present invention there is provideda tracheostomy device comprising a tubular member adapted to provide agas passage into the trachea through an opening in neck tissues and aseal joined with the tubular member, characterised in that the seal isadapted to seal the trachea above the opening and retain the tubularmember in position.

According to a third aspect of the present invention there is provided amethod of enabling flow of gas to a patient's trachea including thesteps of forming a gas passage through neck tissue into the trachea andsealing the trachea against gas flow at a location above the gaspassage.

BRIEF DESCRIPTION OF DRAWINGS

A tracheostomy device according to the present invention will now bedescribed, by way of example, with reference to the accompanyingdrawings, in which:

FIG. 1 is a sectional side elevation view of the device in use;

FIG. 2 is a sectional side elevation view of a part of the device to alarger scale;

FIG. 3 is a end view of the patient end of the part shown in FIG. 2;

FIG. 4 is a sectional side elevation view of a part of an alternativedevice;

FIG. 5 is an end view of the patient end of the part shown in FIG. 4;

FIG. 6 is a cross-sectional view of a part of another alternativedevice; and

FIG. 7 is a sectional side elevation view of a further alternativedevice in use.

DETAILED DESCRIPTION OF INVENTION

With reference first to FIGS. 1 to 3, the device comprises twocomponents namely a tubular component 1 providing an airway into thetrachea 2 and a seal 3 preventing flow of gas along the trachea.

The tubular component 1 comprises a short, stiff, plastics tube 10 ofcircular section. The tube 10 extends through a tracheostomy opening 4through neck tissue 5 overlying the trachea 2 and its length is selectedso that its patient end 11 terminates adjacent the internal end of theopening and its machine end 12 lies closely adjacent the skin surface 7.

Both the machine end 12 and the patient end 11 have some form ofretaining means 13 and 14 respectively to prevent displacement of thetube 10. The external retaining means at the machine end 12 takes theform of a fixed circular flange 13 projecting radially outwardly andabutting the skin surface 7 around the opening 4. The flange 13 may beclear or skin-coloured to make it less conspicuous. The machine end 12of the tube 10 may include

The short length of the tube 10, without any appreciable projection intothe trachea 2, has several advantages. There is less accumulation ofsecretions so maintenance is greatly facilitated. There is less risk ofblockage by obstructions within the tube 10 and there is no risk ofblocking by contact with the carina. The tube 10 affords less resistanceto gas flow than conventional, longer tubes. Also, the short tube 10does not create any obstruction should surgery be needed within thetrachea 2 just below the tracheostomy 4. The absence of a cuffcontacting the trachea below the tracheostomy opening can be anadvantage if there has been damage to the trachea in this region.Because the tube 10 can be securely retained by the internal andexternal retaining means, there is less need to use a strap to securethe external flange around the neck. This can help make the device lessconspicuous than conventional tracheostomy tubes.

Various modifications are possible to the device. The tube could beadjustable in length, such as by screw threading.

Many alternative forms of retaining means are possible. FIGS. 4 and 5show a tube 10′ with an inner retaining means provided by a rotatabletab 45 mounted on one end of a shaft 46 that extends outwardly through alumen 47 in the wall of the tube. By rotating a handle 48 on theexternal end of the shaft, the tab 45 can be swung from a first positionwhere it projects inwardly (for insertion) to a second position where itprojects outwardly (for retaining the tube).

FIG. 6 illustrates a tube 10″ in four longitudinal sections 51 to 54that are foldable with one another along four longitudinal hinge lines55 to 58 and that has fixed flanges 59 at both ends. The tube 10″ iscollapsed to a smaller cross-section for insertion so that the innerflanges 59 do not hinder this. The tube 10″ is then opened out withinthe tracheostomy opening so that the flanges 59 at the ends engage thesurface of the trachea and the skin respectively.

FIG. 7 illustrates an alternative device where the inner retaining meansis provided by the same component that effects the sealing. A deformablesealing ring 60 located above

1. A tracheostomy device including a tubular member adapted to provide agas passage into the trachea through an opening in neck tissues and anexternal retainer for retaining the tubular member with the externalsurface of the neck adjacent the opening, characterized in that thepatient end of the tubular member terminates adjacent the internal endof the opening without extending below the opening, and that the deviceincludes an internal retainer for retaining the tubular member with theinternal surface of the trachea adjacent the opening and a gas seallocated in the trachea above the opening with a lower side exposed togas pressure within the trachea and substantially sealing the tracheaabove the opening against the flow of gas along the trachea in eitherdirection such that gas flow to and from the trachea is confined to thetubular member.
 2. A tracheostomy device according to claim 1,characterized in that the seal includes a fluid passage opening at oneend of the seal and extending out of the trachea via the opening.
 3. Atracheostomy device according to claim 2, characterized in that thefluid passage is a suction passage.
 4. A tracheostomy device accordingto claim 1, characterized in that the seal includes a deformable annularring arranged to engage the surface of the trachea.
 5. A tracheostomydevice according to claim 4, characterized in that the annular ring isinflatable.
 6. A tracheostomy device according to claim 4, characterizedin that the annular ring includes a resilient foam.
 7. A tracheostomydevice according to claim 4, characterized in that the seal includes aweb extending across the ring.
 8. A tracheostomy device according toclaim 1, characterized in that the external retainer is a flange andthat the internal retainer is a displaceable member.
 9. A tracheostomydevice according to claim 8, characterized in that the displaceablemember is a hinged tab, and that the tab is connected with a cord bywhich the tab can be displaced.
 10. A tracheostomy device including atubular member adapted to provide a gas passage into the trachea throughan opening in neck tissues and an external retainer for retaining thetubular member with the external surface of the neck adjacent theopening characterized in that the patient end of the tubular memberterminates adjacent the internal end of the opening, that the deviceincludes an internal retainer for retaining the tubular member with theinternal surface of the trachea adjacent the opening; that the externalretainer is a flange, that the internal retainer is a displaceablemember, that the displaceable member is a hinged tab, and that the tabis connected with a cord by which the tab can be displaced.